Project summary In New York City (NYC), domestic mold contamination has been one of the greatest concerns for public health officials and most common complaints of residents in the aftermath of Hurricane Sandy. Mold problems are common in urban homes in general and disproportionately affect lower-income families who have less control over conditions conducive to mold growth. In urban settings, asthmatic children could be particularly susceptible to adverse health effects related to fungal exposures following catastrophic water damage. A 2004 Institute of Medicine report and several meta-analyses have concluded that mold and home dampness factors are associated with asthma symptoms. However, a majority of this evidence is based on report of dampness or visible mold and not on measured fungal exposure, limiting these studies from demonstrating 1) that fungal exposure was the causative agent, 2) which species of fungi were associated with the health outcomes and 3) whether specific allergic sensitization is an etiological pathway to the asthma-related morbidity. Historically, making these connections was impeded by limitations of traditional methods for assessing domestic mold exposure, including the microscopic identification of morphologically indiscernible spores and species-specific growth conditions required for mold culture and a lack of specificity for mold with bioassays. Recently, advances in polymerase chain reaction methodologies will allow for characterization of fungal profiles associated with water damage, enable monitoring the efficacy of remediation efforts and long-term changes in domestic fungal profiles, and may aid in elucidating the association between fungal exposure and poor respiratory health. This proposal will test the hypotheses that NYC homes with Hurricane Sandy-related water damage will have different fungal species profiles both pre- and post- remediation as compared with NYC homes that were not impacted and that fungal concentrations in homes will be associated with asthma symptoms, airflow obstruction and airway inflammation among asthmatic children. Participants living in NYC homes damaged by Hurricane Sandy will be recruited from a unique public-private partnership that is providing services for free mold remediation for 2,000 houses. An established cohort of seven-eleven year-old asthmatic children living throughout NYC in non-impacted homes will be used to compare exposures and respiratory outcomes with impacted homes and the asthmatics children living in those homes. This proposal will establish collaboration between researchers and public health practitioners at the NYC Department of Health and Mental Hygiene (DOHMH), Columbia University, NIOSH and private industry with complementary expertise and skills to answer important public health research questions in response to this devastating natural disaster. If successful, this proposal will lead to important knowledge about domestic fungal exposure following a natural disaster like Hurricane Sandy in urban communities and the associated increase in asthma morbidity in children. This knowledge will be used by the NYC DOHMH and others to inform the response to future natural disasters, particular to clarify the risks to asthmatic children.